The World of Cancer Centres

Key to successful cancer centres and how to develop them

Dinesh Madhavan President, Group Oncology & International, AHEL

Cancer Care projects have evolved over the years when the projects have been commissioned by selfless crusaders, not for profit institutions supported by the government, central and state government bodies who have envisioned these projects as access to affordable cancer care projects to the last two decades; where we have seen greater access to comprehensive cancer centres, public-private partnerships, stand-alone comprehensive cancer centres, the hospital in hospital model, day-care chemotherapy centres, cancer diagnostic centres, and advanced cancer centres. Thanks to private enterprise which has greatly filled the gap that could not be addressed by public enterprise.

Cancer is not only one of the biggest challenges that the medical fraternity faces but also one that is rapidly evolving. Especially with the advent of biologically targeted treatments and personalised cancer treatments based on genomic sequencing. It is clear that an interdisciplinary approach to integrating research, treatment and care will help address those challenges with improved outcomes, increased patient wellbeing and more effective prevention and treatments in the future. Through these significant investments, hospitals aim to provide the best cancer care. However, infrastructure alone cannot guarantee best in class care. Here are several steps that hospitals can follow to develop a successful cancer centre.

1. Articulate a vision. The management team should start building a cancer centre by developing and articulating a vision for cancer care. The promoters and leadership need to agree on a vision for the centre that includes the size of the centre, clinical program, its mission, standards, and its goals inpatient care.
2. Develop a strategic plan. Once leaders of the hospital and service line support a common vision, they need to develop a strategic plan with the disease burden in the geography, mapping of the cancer care providers and policies on cancer.
3. Design – The design of cancer centres must not only address the clinical requirements but also consider ways in which patient wellbeing can be optimised through the design and layout of the space in order to maximise positive outcomes. Operationally, cancer centres must be flexible enough to adapt to new approaches to care and treatment and new technologies. They must also be able to integrate the treatment of patients with the research value of a live cancer care environment by providing an interdisciplinary setting.
4. Cancer Management Teams – To begin staffing a cancer centre, hospitals need to recruit a multidisciplinary team of clinicians. One of the keys to a successful cancer centre is focussed cancer management teams that specialize in a specific type of cancer only. It is an impossible task to expect cancer specialist to keep up with the rapid pace of new developments in every cancer and also master that domain.
5. Advance technology – Advances in technology has played a very important role in accurately diagnosing cancers and also for precise treatment that has shown to improve outcomes. Some of the advances in acceptance of technology that have made a difference are robotic surgery, robotic radio Dinesh Mahajan President, Group Oncology & International, AHEL surgery, digital PET CT, digital pathology, intraoperative MRI, proton therapy, tom synthesis, adaptive radiotherapy and molecular lab.
6. Support Group and Foundation – Cancer winners and survivors are of great support and guide for newly diagnosed cancer patients, they repose faith on how cancer can be overcome and you could live a life free of cancer or a qualitative life with cancer. Support groups in hospitals or communities have proven to be beneficial in ensuring guidance, addressing concerns and also taking care of many an emotional aspect. In addition to the support groups, a cancer foundation that could help the economically challenged to access qualitative cancer care is crucial to ensure better access to cancer care and no one is deprived of treatment for financial reasons.
7. Offer clinical trials. After establishing a robust clinical programme with specialised teams and advanced technology, hospitals should consider offering clinical trials as a way to increase treatment options for patients. This gives them the opportunity to try new medications and therapies that may result in better outcomes.1Focus on the patient experience. As an additional step, hospitals that aim to be recognised for strong cancer services need to focus on the patient experience when delivering care. A patient’s experience is shaped by everything and everyone in the care environment.
8. Expansion and Improvement – Cancer care is fast evolving and thus the need to embrace newer models of treatment and the technology that are introduced, it is thus important that every cancer project is structured in 2-3 phases and a continuous improvement plan in services and technology upgrade is planned. Planning for this from expertise, tech advancements and funding is important.
9. Raise awareness on various cancers – It is important that awareness is raised on various cancers, its prevention, screening treatment options, living with cancers and life after cancer.
10. Advocacy – Cancer centres should take the lead and actively participate to ensure that policies on cancer and its management are reviewed with government bodies, changes or improvements are made that will help in identification, prevention, screening, diagnosing, notification, national policy, incidence and integrating with the national cancer grid.

The move towards specialist cancer centres to support the work carried out in treating and caring for patients in hospital oncology departments is creating scope for specialist expertise in the design of cancer care environments. A ‘hub and spoke’ model for patient care with comprehensive cancer centres at its core, feeding into major urban cancer units and regional hospitals enable appropriate treatment and care to be delivered at varying stages in the patient’s treatment journey, supporting both optimisations of resources and patient wellbeing. The typical project completion period for a cancer centre is around three years, with the design period taking up to 12 months and a further two years required for construction, fit-out and commissioning. There is an increasing design emphasis on how cancer centre environments affect patients’ anxiety levels and wellbeing, which, ultimately, influence outcomes.

The challenge is aligning clinical pathways with spatial design, rather than allowing spatial planning to be determined on a silo departmental basis. Practical operational considerations, such as building services engineering, weight loading and access, must be factored into this approach, but the treatment pathways must be the starting point. Furthermore, the facility’s research objectives must be built into the patient journey to ensure that diagnostics, research and treatment are seamlessly integrated. Making research visible to patients reassures them that their treatment is up to date and of the highest quality, encouraging higher rates of participation in clinical trials.

Ultimately, the purpose of designing specialist cancer care units is to support patient wellbeing and improve outcomes. This can only be done with an approach that puts consultation at the centre of achieving a bespoke design that meets the needs of specific professionals and patients.